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Long Term Follow-Up

1 Formulär  
  1. StudyEvent: ODM
    1. Long Term Follow-Up
Long Term Follow-Up (Year 14)
Beskrivning

Long Term Follow-Up (Year 14)

Center
Beskrivning

Center Number

Datatyp

integer

Visit
Beskrivning

Visit Type

Datatyp

text

Visit Date
Beskrivning

Visit Date

Datatyp

date

Alias
UMLS CUI [1]
C1320303
Subject number
Beskrivning

Subject number

Datatyp

integer

Alias
UMLS CUI [1]
C2348585
BLOOD SAMPLING
Beskrivning

BLOOD SAMPLING

I certify that Informed Consent has been obtained prior to any study procedure.
Beskrivning

Consent

Datatyp

boolean

Informed Consent Date :
Beskrivning

Informed Consent Date

Datatyp

date

DEMOGRAPHICS
Beskrivning

DEMOGRAPHICS

Date of birth:
Beskrivning

Birth Date

Datatyp

date

Subject Initials
Beskrivning

Subject Initials

Datatyp

text

Måttenheter
  • _ _ First Name / _ _ Family Name
Alias
UMLS CUI [1]
C2986440
_ _ First Name / _ _ Family Name
LABORATORY TESTS
Beskrivning

LABORATORY TESTS

Has a blood sample been taken ?
Beskrivning

BLOOD SAMPLE

Datatyp

boolean

INVESTIGATOR SIGNATURE
Beskrivning

INVESTIGATOR SIGNATURE

Date
Beskrivning

Date

Datatyp

date

Investigator signature :
Beskrivning

Investigator signature

Datatyp

text

Long Term Follow-Up (Year 15)
Beskrivning

Long Term Follow-Up (Year 15)

Center
Beskrivning

Center Number

Datatyp

integer

Subject Initials
Beskrivning

First Name, Family Name

Datatyp

text

Subject Number
Beskrivning

Subject Number

Datatyp

integer

BLOOD SAMPLING
Beskrivning

BLOOD SAMPLING

I certify that Informed Consent has been obtained prior to any study procedure.
Beskrivning

Consent

Datatyp

boolean

Informed Consent Date:
Beskrivning

Informed Consent Date

Datatyp

date

DEMOGRAPHICS
Beskrivning

DEMOGRAPHICS

Date of birth:
Beskrivning

Birth Date

Datatyp

date

Subject Initials
Beskrivning

Subject Initials

Datatyp

text

Måttenheter
  • _ _ First Name / _ _ Family Name
Alias
UMLS CUI [1]
C2986440
_ _ First Name / _ _ Family Name
LABORATORY TESTS
Beskrivning

LABORATORY TESTS

Has a blood sample been taken?
Beskrivning

BLOOD SAMPLE

Datatyp

boolean

INVESTIGATOR SIGNATURE
Beskrivning

INVESTIGATOR SIGNATURE

Date
Beskrivning

Date

Datatyp

date

Investigator signature :
Beskrivning

Investigator signature

Datatyp

text

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Similar models

Long Term Follow-Up

1 Formulär
  1. StudyEvent: ODM
    1. Long Term Follow-Up
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Long Term Follow-Up (Year 14)
Center Number
Item
Center
integer
Item
Visit
text
Visit Type
Code List
Visit
CL Item
Blood Sampling (Year 14) (1)
Visit Date
Item
Visit Date
date
C1320303 (UMLS CUI [1])
Subject number
Item
Subject number
integer
C2348585 (UMLS CUI [1])
Item Group
BLOOD SAMPLING
Consent
Item
I certify that Informed Consent has been obtained prior to any study procedure.
boolean
Informed Consent Date
Item
Informed Consent Date :
date
Item Group
DEMOGRAPHICS
Birth Date
Item
Date of birth:
date
Subject Initials
Item
Subject Initials
text
C2986440 (UMLS CUI [1])
Item Group
LABORATORY TESTS
BLOOD SAMPLE
Item
Has a blood sample been taken ?
boolean
Item Group
INVESTIGATOR SIGNATURE
Date
Item
Date
date
Investigator signature
Item
Investigator signature :
text
Item Group
Long Term Follow-Up (Year 15)
Center Number
Item
Center
integer
Subject identification
Item
Subject Initials
text
Subject Number
Item
Subject Number
integer
Item Group
BLOOD SAMPLING
Consent
Item
I certify that Informed Consent has been obtained prior to any study procedure.
boolean
Informed Consent Date
Item
Informed Consent Date:
date
Item Group
DEMOGRAPHICS
Birth Date
Item
Date of birth:
date
Subject Initials
Item
Subject Initials
text
C2986440 (UMLS CUI [1])
Item Group
LABORATORY TESTS
BLOOD SAMPLE
Item
Has a blood sample been taken?
boolean
Item Group
INVESTIGATOR SIGNATURE
Date
Item
Date
date
Investigator signature
Item
Investigator signature :
text
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